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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018725
Report Date: 03/14/2022
Date Signed: 03/14/2022 04:52:57 PM


Document Has Been Signed on 03/14/2022 04:52 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:TUJUNGA CANYON PRESCHOOL ACADEMYFACILITY NUMBER:
198018725
ADMINISTRATOR:ALINA POGOSYANFACILITY TYPE:
850
ADDRESS:9901 TUJUNGA CANYON BLVD.TELEPHONE:
(818) 353-9333
CITY:TUJUNGASTATE: CAZIP CODE:
91042
CAPACITY:110CENSUS: 65DATE:
03/14/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:32 AM
MET WITH:Alina Pogosyan, LicenseeTIME COMPLETED:
05:03 PM
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On 03/14/2022, Licensing Program Analyst (LPAs) Liana Stepanyan and Monique Ayala met with Alina Pogosyan who guided LPAs on a tour of the facility. Upon arrival, LPAs observed 65 children under care and supervision with 9 staff members. The purpose of this visit was to conduct a Case Management (inspection) regarding an unusual incident that occurred at the facility 10/01/2021 and was received at the Department on 10/04/2021. This incident was reported timely. The unusual incident indicated that on 10/01/2021, child #1 was washing his hands when staff #1 heard a loud bang and went to assist staff #2 with tray full of snacks that fell to the floor. Few seconds later child #1 walked back to the classroom opening the door and swinging it couple of times before his finger is caught in the middle of the door. Child #2 helps child #1 to release his finger free, teacher returns a few seconds later finding Child #1 hurt. First Aid measures were taken, child #1’s grandmother picked him up shortly after. Child #1 had sustained a fracture from the incident.

On today’s inspection, LPAs interviewed staff, children, and child #1’s parent and obtained copy of classroom roster and other relevant documents. Based on interviews conducted, it was revealed the staff #1 did not have visual supervision on child #1 when incident occurred. Staff #2 fell and dropped snacks and staff #1 went to assist staff #2 during that time child #1 was swinging the door and caught his finger in between the door. Child #2 assisted child #1 to remove his finger from in between the door. Staff #1 and staff #2 heard commotion and entered the classroom to see child #1 injured.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Liana StepanyanTELEPHONE: 661-202-3380
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: TUJUNGA CANYON PRESCHOOL ACADEMY
FACILITY NUMBER: 198018725
VISIT DATE: 03/14/2022
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Staff #1 and staff #2 applied first aid. Staff #1 called child #1’s parent to inform about the incident. Approximately 40 minutes later child #1’s grandmother picked child up. Child #1 was taken to the emergency room where it was disclosed child #1's finger was fractured due to the incident.

An immediate civil penalty of $500 is being assessed and $100 will accrue until the deficiency is corrected.

The facility is being cited a Type A deficiency according to the California Code Title 22 Regulations, 101229(a)(1). This citation poses an immediate health and safety risk. See LIC 809D for deficiencies.
Upon receipt of a Type A deficiency licensee shall post the report for 30 days in addition to the Notice of Site Visit & provide copies of the licensing report to parents/guardians of children in care at the facility. This report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee will obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. If these requirements are not met, civil penalties will be assessed.

An exit interview was conducted, a copy of this report and appeal rights was provided to licensee with Notice of Site Visit.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Liana StepanyanTELEPHONE: 661-202-3380
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 03/14/2022 04:52 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: TUJUNGA CANYON PRESCHOOL ACADEMY
FACILITY NUMBER: 198018725

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/14/2022
Section Cited

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Responsibility for providing care and supervision: The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without supervision of a teacher at any time,...supervision shall include visual observation. The requirement was not met as evidence by:
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Based on interviews child #1 obtained a finger injury due to classroom door closing on child #1s finger and child #1 needing medical attention that resulted in child #1 obtaining a fracture on child's finger. Staff #1 was not present during the time of the incident that occurred to child #1. This poses an immediate health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Liana StepanyanTELEPHONE: 661-202-3380
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2022
LIC809 (FAS) - (06/04)
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